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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Pharmacol.</journal-id>
<journal-title>Frontiers in Pharmacology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Pharmacol.</abbrev-journal-title>
<issn pub-type="epub">1663-9812</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">1067408</article-id>
<article-id pub-id-type="doi">10.3389/fphar.2023.1067408</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Pharmacology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>
<italic>In vitro</italic> metabolic characterization of the SARS-CoV-2 papain-like protease inhibitors GRL0617 and HY-17542</article-title>
<alt-title alt-title-type="left-running-head">Cho et al.</alt-title>
<alt-title alt-title-type="right-running-head">
<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fphar.2023.1067408">10.3389/fphar.2023.1067408</ext-link>
</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Cho</surname>
<given-names>Hyunki</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2162032/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Young Jun</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1319658/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Chae</surname>
<given-names>Jung-Woo</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/691210/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Meyer</surname>
<given-names>Markus R.</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/919354/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Kim</surname>
<given-names>Sang Kyum</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1590095/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Ryu</surname>
<given-names>Chang Seon</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/363836/overview"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Environmental Safety Group</institution>, <institution>KIST Europe Forschungsgesellschaft mbH</institution>, <addr-line>Saarbr&#xfc;cken</addr-line>, <country>Germany</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Pharmacy</institution>, <institution>Saarland University</institution>, <addr-line>Saarbr&#xfc;cken</addr-line>, <country>Germany</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>College of Pharmacy</institution>, <institution>Chungnam National Univerisity</institution>, <addr-line>Daejeon</addr-line>, <country>Republic of Korea</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Department of Experimental and Clinical Toxicology</institution>, <institution>Center for Molecular Signaling (PZMS)</institution>, <institution>Institute of Experimental and Clinical Pharmacology and Toxicology</institution>, <institution>Saarland University</institution>, <addr-line>Homburg</addr-line>, <country>Germany</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1534875/overview">Grover Paul Miller</ext-link>, University of Arkansas for Medical Sciences, United States</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2052360/overview">David Stresser</ext-link>, AbbVie, United States</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2111834/overview">Chul-Ho Yun</ext-link>, Chonnam National University, Republic of Korea</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Sang Kyum Kim, <email>sangkim@cnu.ac.kr</email>; Chang Seon Ryu, <email>changryu@kist-europe.de</email>
</corresp>
<fn fn-type="other">
<p>This article was submitted to Drug Metabolism and Transport, a section of the journal Frontiers in Pharmacology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>15</day>
<month>02</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2023</year>
</pub-date>
<volume>14</volume>
<elocation-id>1067408</elocation-id>
<history>
<date date-type="received">
<day>11</day>
<month>10</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>03</day>
<month>02</month>
<year>2023</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2023 Cho, Kim, Chae, Meyer, Kim and Ryu.</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Cho, Kim, Chae, Meyer, Kim and Ryu</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>The SARS-CoV-2 pandemic requires a new therapeutic target for viral infection, and papain-like protease (Plpro) has been suggested as a druggable target. This <italic>in-vitro</italic> study was conducted to examine the drug metabolism of the GRL0617 and HY-17542, Plpro inhibitors. Metabolism of these inhibitors was studied to predict the pharmacokinetics in human liver microsomes. The hepatic cytochrome P450 (CYP) isoforms responsible for their metabolism were identified using recombinant enzymes. The drug&#x2013;drug interaction potential mediated by cytochrome P450 inhibition was estimated. In human liver microsomes, the Plpro inhibitors had phase I and phase I &#x2b; II metabolism with half-lives of 26.35 and 29.53&#xa0;min, respectively. Hydroxylation (M1) and desaturation (-H2, M3) of the para-amino toluene side chain were the predominant reactions mediated with CYP3A4 and CYP3A5. CYP2D6 is responsible for the hydroxylation of the naphthalene side ring. GRL0617 inhibits major drug-metabolizing enzymes, including CYP2C9 and CYP3A4. HY-17542 is structural analog of GRL0617 and it is metabolized to GRL0617 through non-cytochrome P450 reactions in human liver microsomes without NADPH. Like GRL0617 and HY-17542 undergoes additional hepatic metabolism. The <italic>in-vitro</italic> hepatic metabolism of the Plpro inhibitors featured short half-lives; preclinical metabolism studies are needed to determine therapeutic doses for these inhibitors.</p>
</abstract>
<kwd-group>
<kwd>GRL0617</kwd>
<kwd>cytochrome P450</kwd>
<kwd>hepatic metabolism</kwd>
<kwd>LC-QTOF</kwd>
<kwd>human liver microsome</kwd>
</kwd-group>
<contract-num rid="cn001">2021003310001</contract-num>
<contract-sponsor id="cn001">Korea Environmental Industry and Technology Institute<named-content content-type="fundref-id">10.13039/501100003654</named-content>
</contract-sponsor>
</article-meta>
</front>
<body>
<sec id="s1">
<title>1 Introduction</title>
<p>GRL0617 {5-amino-2-methyl-N-[(1R)-1-(1-naphthalenyl)ethyl]benzamide} was developed as a papain-like protease (Plpro) inhibitor and candidate antiviral agent (<xref ref-type="bibr" rid="B23">Ratia et al., 2008</xref>). HY-17542 {5-[acetylamino]-2-methyl-N-[(1R)-1-(1-naphthalenyl)ethyl]benzamide} is an acetylated form of GRL0617 (<xref ref-type="fig" rid="F1">Figure 1</xref>). With the SARS-CoV-2 pandemic, GRL0617 and HY-17542 were repurposed as drug candidates for SARS-CoV-2 infection treatment (<xref ref-type="bibr" rid="B26">Shin et al., 2020</xref>; <xref ref-type="bibr" rid="B6">Fu et al., 2021</xref>), and their compatibility with SARS-CoV-2 drugs was assessed. The oral antiviral agents Paxlovid (nirmatrelvir/ritonavir) and Lagevrio (molnupiravir) were approved during the pandemic for the treatment of SARS-CoV-2 infection. Their therapeutic targets differ from those of Plpro inhibitors, and the development of drugs with new therapeutic targets is needed. Structure-based drug design has been used to improve the inhibition potency of GRL0617 and HY-17542 against SARS-CoV and SARS-CoV-2 (<xref ref-type="bibr" rid="B23">Ratia et al., 2008</xref>; <xref ref-type="bibr" rid="B7">Ghosh et al., 2009</xref>; <xref ref-type="bibr" rid="B8">Ghosh et al., 2010</xref>; <xref ref-type="bibr" rid="B6">Fu et al., 2021</xref>). However, the absorption, distribution, metabolism, excretion, and toxicology (ADMET) and pharmacokinetic proprieties of these Plpro inhibitors have not been evaluated. The aims of this study were to identify hepatic metabolites of GRL0617 and HY-17542 and evaluate their potential drug&#x2013;drug interaction mediated by cytochrome P450 (CYP) inhibition. The metabolism of GRL0617 and HY-17542 was evaluated <italic>in vitro</italic> in human liver microsomes (HLMs) and analyzed using liquid chromatography quadrupole time-of-flight (LC-QTOF) high-resolution mass spectrometry (HRMS). In addition, CYP isoforms responsible for GRL0617 metabolism were identified using recombinant CYP enzymes. Finally, CYP inhibition assays were conducted to evaluate potential drug&#x2013;drug interactions.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>Structure of GRL0617 and HY-17542.</p>
</caption>
<graphic xlink:href="fphar-14-1067408-g001.tif"/>
</fig>
</sec>
<sec sec-type="materials|methods" id="s2">
<title>2 Materials and methods</title>
<sec id="s2-1">
<title>2.1 Chemicals and reagents</title>
<p>GRL0617 (CAS no. 1093070-16-6) was obtained from Bio-Techne GmbH (Wiesbaden, Germany), and HY-17542 (1093070-14-4) was obtained from MedChemExpress LLC (Monmouth Junction, NJ, United States). Pooled HLMs (UltraPool HLM 150) were purchased from Corning (Woburn, MA, United States). Formic acid, NADPH, DMSO, and formaldehyde were purchased from Sigma Aldrich (St. Louis, MO, United States). All other reagents and chemicals were of the highest grade available commercially. Control, CYP1A2, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2D6, CYP2E1, CYP3A4, and CYP3A5 recombinant CYP bactosomes, carboxylesterase (CES) 1 and CES2 were purchased from Cypex (Dundee, UK). Silensome control, Silensome CYP2D6 and Silensome CYP3A4 were purchased from Biopredic international (Saint Gr&#xe9;goire, France).</p>
</sec>
<sec id="s2-2">
<title>2.2 <italic>In vitro</italic> metabolism study</title>
<sec id="s2-2-1">
<title>2.2.1 Metabolic stability assessment and metabolite identification</title>
<p>Microsomal incubation was conducted in triplicate using 0.1&#xa0;M potassium phosphate buffer (PPB, pH 7.4) in eight-well tube strips in an 8 &#xd7; 12 rack (1.2&#xa0;mL; VWR, Emeryville, CA, United States). NADPH-dependent metabolism was evaluated by incubating 1&#xa0;&#xb5;M GRL0617 or HY-17542 with a NADPH regenerating system (1&#xa0;mM NADP&#x2b;, 5&#xa0;mM G6P, 1&#xa0;U/mL G6PDH) and 1&#xa0;mg/mL pooled HLMs. The mixture was pre-incubated at 37&#xb0;C with shaking at approximately 100&#xa0;rpm for 5&#xa0;min. UGT glucuronidation was performed with HLMs (1&#xa0;mg/mL) and alamethicin (25&#xa0;&#x3bc;g/mg microsomal protein) in a 100-mM PPB (pH 7.4) solution on ice for 15&#xa0;min. After the addition of GRL0617 or HY-17542 (1&#xa0;&#xb5;M) and saccharic acid (1,4-lactone, 5&#xa0;mM), the mixture was pre-incubated at 37&#xb0;C for 5&#xa0;min. CYP, UGT, and combined reactions were initiated by addition of the NADPH regenerating system, UDPGA (1&#xa0;mM), and both, respectively. The reactions were quenched with 200&#xa0;&#xb5;L ice-cold acetonitrile containing 50&#xa0;nM carbamazepine (CBZ) as an internal standard at 0, 5, 15, 30, 45, and 60&#xa0;min for GRL0617, and 0, 3, 6, 10, 15, 30, and 60&#xa0;min for HY-17542. The incubation mixtures were then centrifuged at 2,000 &#xd7; g and 4&#xb0;C for 20&#xa0;min, and the supernatants were analyzed by LC-QTOF HRMS.</p>
<p>CYP-dependent metabolism of GRL0617 was evaluated at various concentrations (1, 3.3, 10, 25, and 50&#xa0;&#xb5;M) in 0.1&#xa0;M PPB (pH 7.4) with 1&#xa0;mg/mL HLM for 0, 5, 15, 30, 45, and 60&#xa0;min incubation time. The incubation mixtures were pre-incubated at 37&#xb0;C in a shaking water bath at approximately 100&#xa0;rpm for 5&#xa0;min. Reactions were initiated by the addition of an NADPH-regenerating system. The reaction was terminated, centrifuged then analyzed using the same method described above.</p>
</sec>
<sec id="s2-2-2">
<title>2.2.2 Reaction phenotyping</title>
<p>Reactions were conducted in triplicate using 0.1&#xa0;M PPB (pH 7.4) in eight-well tube strips in an 8 &#xd7; 12 rack. The CYP isoforms responsible for metabolism were identified by incubating GRL0617 or HY-17542 (1&#xa0;&#xb5;M) with 50&#xa0;pmol/mL of each EasyCYP which co-expressed 100&#xa0;pmol/mg protein CYPs (CYP1A2, 2A6, 2B6, 2C8, 2C9, 2D6, 2E1, 3A4, 3A5, and control) together 1,000&#xa0;nmol/min/mg protein cytochrome P450 reductase (CPR) in the presence of a NADPH-regenerating system at a final volume of 200&#xa0;&#xb5;L for 60&#xa0;min. The mixture was pre-incubated at 37&#xb0;C with shaking at approximately 100&#xa0;rpm for 5&#xa0;min. Reactions were initiated by the addition of the NADPH-regenerating system and quenched with 200&#xa0;&#xb5;L ice-cold acetonitrile containing 50&#xa0;nM CBZ. The samples were centrifuged at 1,000 &#xd7; g and 4&#xb0;C for 20&#xa0;min, and the supernatants were subjected to LC-QTOF HRMS. To determine the enzyme kinetic parameters, various concentrations (0, 0.22, 0.62, 1.85, 5.56, 16.67, and 50&#xa0;&#xb5;M) of GRL0617 were incubated in 0.1&#xa0;M PPB (pH 7.4) with 50&#xa0;pmol/mL of each recombinant CYP2D6, CYP3A4 or CYP3A5 enzyme. The reaction was incubated, initiated, terminated, centrifuged then analyzed using the same method described above.</p>
</sec>
<sec id="s2-2-3">
<title>2.2.3 CYP inhibition assay</title>
<p>The drug&#x2013;drug interaction potential was evaluated using a CYP cocktail assay that involved microsomal incubation and NADPH, as described elsewhere (<xref ref-type="bibr" rid="B13">Lee et al., 2012</xref>). Time-dependent inhibitions of CYP2C9 (tolbutamide as a selective substrate) and CYP3A4 (midazolam and testosterone as selective substrates) were evaluated using non-dilution method (<xref ref-type="bibr" rid="B17">Parkinson et al., 2011</xref>) with the same concentration range of GRL0617 used direct inhibition (0&#x2013;50&#xa0;&#xb5;M) in total volume of 180&#xa0;&#xb5;L per tube consisting of 0.1&#xa0;M PPB (pH 7.4). The first reactions were initiated by NADPH addition, and each mixture was incubated in a shaking water bath at 37&#xb0;C for 30&#xa0;min. The final incubation was performed for 10&#xa0;min with a total volume of 200&#xa0;&#xb5;L by adding substrates (tolbutamide (set B) as a CYP2C9 selective substrate, midazolam (set A) and testosterone (set B) as CYP3A4 selective substrates) and NADPH. The reaction was stopped and quenched by adding 200&#xa0;&#xb5;L of ice-cold acetonitrile containing 50&#xa0;nM CBZ as internal standard, then centrifuged at 3,000 x g for 20&#xa0;min. The supernatants were injected in LC-QTOF system. IC<sub>50</sub> shift values were calculated as the ratio of the IC<sub>50</sub> value obtained after pre-incubation without NADPH divided by the IC<sub>50</sub> value obtained after 30&#xa0;min incubation with NADPH. Based on IC<sub>50</sub> shifts more than 1.5-fold, the inhibitor was determined to be time-dependent inhibitor (<xref ref-type="bibr" rid="B3">Berry and Zhao, 2008</xref>).</p>
</sec>
<sec id="s2-2-4">
<title>2.2.4 Instruments and analytical conditions</title>
<p>The LC-QTOF system consisted of an Exion AD LC device (AB Sciex, Framingham, MA, United States) and a TripleTOF 6,600 &#x2b; system (AB Sciex) equipped with an IonDrive Turbo V source operated in positive TOF information-dependent acquisition (IDA) MS2 scan mode. The TOF scan dwell time was 50&#xa0;ms, and the 20 &#xd7; IDA MS2 scan time was acquired with a 30-ms dwell time. Separation was performed using a ZORBAX rapid-resolution high-definition (RRHD) Eclipse Plus C18 column (95&#xa0;&#xc5;, 2.1 &#xd7; 100&#xa0;mm, 1.8&#xa0;&#xb5;m; Agilent Technologies, Santa Clara, CA, United States) coupled with an RRHD Eclipse Plus C18 guard column (2.1&#xa0;mm &#xd7; 5&#xa0;mm, 1.8&#xa0;&#xb5;m; Agilent Technologies). The autosampler was operated at 4&#xb0;C and the column oven was operated at 40&#xb0;C, with an injection volume of 5&#xa0;&#x3bc;L. The flow rate for mobile phases A (0.1% formic acid in water) and B (acetonitrile) was 0.3&#xa0;mL/min. The initial composition of mobile phase B was 5%, which was maintained for 2&#xa0;min and then increased to 20% for 2&#xa0;min and 100% by 16&#xa0;min, with maintenance for 2&#xa0;min. The phases were then re-equilibrated at the initial condition for 2&#xa0;min. The GS1, GS2, and curtain gas were set at 50, 50, 35 psi, respectively, and the ion spray voltage was 5,500&#xa0;V. The collision energy for the MS2 scan was 30&#xa0;eV with a 15-eV spread. CYP inhibition was assessed by detecting metabolite ions in incubated samples using the high-resolution multiple reaction monitoring (MRMhr) method with the LC-QTOF system. MRMhr transition of metabolites were described in <xref ref-type="sec" rid="s10">Supplementary Table S1</xref>.</p>
</sec>
</sec>
<sec id="s2-3">
<title>2.3 Statistical analysis</title>
<p>For all LC&#x2013;MS/MS analyses, the peak areas of the parent compounds (GRL0617 and HY-17542) and metabolites were expressed as ratios to the internal standard peak areas for each test substance concentration. In the microsomal stability analysis, degradation half-life (t&#xbd;) values were calculated using the following equation: <inline-formula id="inf1">
<mml:math id="m1">
<mml:mrow>
<mml:mi mathvariant="normal">t</mml:mi>
<mml:mo>&#xbd;</mml:mo>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0.693</mml:mn>
<mml:mo>/</mml:mo>
<mml:mi mathvariant="normal">k</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> where k is the first-order degradation rate constant, estimated by one-phase exponential-decay non-linear regression of the degradation time-course data using Graph Pad Prism 8.0 (Graph Pad Software Inc., San Diego, CA, United States). <italic>In vitro</italic> metabolic stability parameters, microsomal intrinsic clearance (CLint,mic), apparent intrinsic clearance (CL&#x2032;int), and hepatic clearance (CL<sub>h</sub>), were calculated according to the well-stirred model approach (<xref ref-type="bibr" rid="B16">Pang and Rowland, 1977</xref>; <xref ref-type="bibr" rid="B2">Baranczewski et al., 2006</xref>). The apparent kinetic parameters of GRL0617 metabolism were determined by fitting a one-enzyme Michaelis-Menten equation. The kinetic parameters were estimated by plotting the activities over the logarithm of GRL0617 concentration with GraphPad Prism 8.0 (GraphPad Software Inc., San Diego, United States). All data are presented as mean &#xb1; SD. Data were compared between groups using the unpaired Student&#x2019;s t-test. The significance level was set at <italic>p</italic> &#x3c; 0.05, unless indicated otherwise.</p>
</sec>
</sec>
<sec sec-type="results" id="s3">
<title>3 Results</title>
<sec id="s3-1">
<title>3.1 Metabolic stability and characterization of metabolic reaction of GRL0617 and HY-17542</title>
<p>The identities of metabolites were elucidated based on accurate mass isotope patterns in TOF MS scans and MS2 fragmentation comparisons with GRL0617 and HY-17542 standards. The chromatographic and MS fragmentation patterns of GRL0617 and HY-17542 were investigated. GRL0617 and HY-17542 eluted at 5.93 and 6.7&#xa0;min, respectively, and exhibited triple protonated molecular ions at m/z 305.1563, 306.1683, and 307.1710 and 347.1767, 348.1792, and 349.1817, respectively, in positive ion mode (<xref ref-type="fig" rid="F2">Figures 2A, C</xref>). The isotopic distributions of GRL0617 and HY-17542 matched well, with &#x3c;5&#xa0;ppm error. GRL0617 was fragmented at m/z 177.1013 (C<sub>10</sub>H<sub>13</sub>N<sub>2</sub>O<sup>&#x2b;</sup>), 155.0850 (C<sub>12</sub>H<sub>11</sub>&#x2b;), 151.0852 (C<sub>8</sub>H<sub>11</sub>N<sub>2</sub>O<sup>&#x2b;</sup>), 134.0588 (C<sub>8</sub>H<sub>8</sub>NO<sup>&#x2b;</sup>), 129.0687 (C<sub>10</sub>H<sub>9</sub>
<sup>&#x2b;</sup>), and 108.0792 (C<sub>7</sub>H<sub>10</sub>N<sup>&#x2b;</sup>), and HY-17542 was fragmented at m/z 219.1131 (C<sub>12</sub>H<sub>15</sub>N<sub>2</sub>O<sub>2</sub>
<sup>&#x2b;</sup>), 193.0968 (C<sub>10</sub>H<sub>13</sub>N<sub>2</sub>O<sub>2</sub>
<sup>&#x2b;</sup>), 176.0701 (C<sub>8</sub>H<sub>10</sub>N<sub>2</sub>O<sub>2</sub>
<sup>&#x2b;</sup>), 155.0851 (C<sub>12</sub>H<sub>11</sub>
<sup>&#x2b;</sup>), 129.0699 (C<sub>10</sub>H<sub>9</sub>
<sup>&#x2b;</sup>), and 106.0639 (C<sub>8</sub>H<sub>10</sub>
<sup>&#x2b;</sup>). GRL-0617 and HY-17542 shared the C<sub>12</sub>H<sub>11</sub> and C<sub>10</sub>H<sub>9</sub> fragment ions containing a naphthalene ring (<xref ref-type="fig" rid="F2">Figures 2B, D</xref>).</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>QTOF mass spectra of GRL0617 and HY-17542, obtained in the ESI &#x2b; mode. <bold>(A)</bold> MS spectrum of GRL0617, <bold>(B)</bold> MS/MS spectrum and fragmentation pattern of GRL0617, <bold>(C)</bold> MS spectrum of HY-17542, and <bold>(D)</bold> MS/MS spectrum and fragmentation pattern of HY-17542.</p>
</caption>
<graphic xlink:href="fphar-14-1067408-g002.tif"/>
</fig>
<p>The NADPH- and UDPGA-dependent metabolic stability of GRL0617 (1&#xa0;&#xb5;M) was determined by monitoring the disappearance of the parent compound and formation of metabolites in HLMs. For reactions conducted with NADPH and NADPH &#x2b; UDPGA, data were collected at six timepoints between 0 and 60&#xa0;min; for those conducted with UDGPA, assessment was performed at 0 and 60&#xa0;min. The GRL0617 concentration decreased to 44.5% &#xb1; 5.3%, 93.4% &#xb1; 6.1%, and 47.2% &#xb1; 7.5% of the initial GRL0617 concentration after 60&#xa0;min incubation with NADPH, UDPGA, and NADPH &#x2b; UDPGA, respectively (<xref ref-type="fig" rid="F3">Figure 3A</xref>). No direct UGT glucuronidation was detected in HLM with UDPGA only. The calculated half-life of NADPH-dependent and NADPH &#x2b; UDPGA-dependent metabolisms were 26.4 and 29.5&#xa0;min, respectively.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>Metabolic stability of GRL0617 in HLMs. <bold>(A)</bold> 1&#xa0;&#xb5;M of GRL0617 was incubated in HLMs with NADPH, NADPH plus UDPGA, or UDPGA. <bold>(B)</bold> Formation of hydroxy metabolite, M1. 1&#xa0;&#xb5;M of GRL0617 was incubated in HLMs with NADPH, NADPH plus UDPGA. <bold>(C)</bold> Formation of desaturated metabolite, M3. 1&#xa0;&#xb5;M of GRL0617 was incubated in HLMs with NADPH, NADPH plus UDPGA. Each value represents the mean &#xb1; SD (<italic>n</italic> &#x3d; 3). <bold>(D)</bold> Various concentrations (1, 3.3, 10, 25, and 50&#xa0;&#xb5;M) of GRL0617 were incubated in 0.1&#xa0;M PPB (pH 7.4) with 1&#xa0;mg/mL HLM and NADPH for 0, 5, 15, 30, 45, and 60&#xa0;min. <bold>(E)</bold> For determination of M1 formation, various concentrations (1, 3.3, 10, 25, and 50&#xa0;&#xb5;M) of GRL0617 was incubated in HLMs with NADPH. <bold>(F)</bold> For determination of M3 formation, various concentrations (1, 3.3, 10, 25, and 50&#xa0;&#xb5;M) of GRL0617 were incubated in HLMs with NADPH. Data are presented as mean &#xb1; SD from three independent samples (<italic>n</italic> &#x3d; 3). <bold>(G)</bold> Representative chromatogram of GRL0617 and its metabolites from QTOF MS analysis in HLMs with NADPH. <bold>(H)</bold> Representative chromatogram of GRL0617 and its metabolites from QTOF MS analysis in HLMs with NADPH plus UDPGA.</p>
</caption>
<graphic xlink:href="fphar-14-1067408-g003.tif"/>
</fig>
<p>The CLint, mic in HLM incubated with NADPH or NADPH &#x2b; UDPGA was 26.3 or 23.5&#xa0;&#x3bc;L/min/mg protein, respectively (<xref ref-type="table" rid="T1">Table 1</xref>). By <italic>in vitro-in vivo</italic> extrapolation of the kinetic data measured in HLM, the CL&#x2032;int and CL<sub>h</sub> values <italic>in vivo</italic> of NADPH- or NADPH &#x2b; UDPGA-dependent metabolism were 27.0 and 11.7 or 24.1 and 11.1&#xa0;mL/min/kg, respectively. The CL<sub>h</sub> of GRL0617 was approximately half of the hepatic blood flow rate (20.7&#xa0;mL/min/kg).</p>
<table-wrap id="T1" position="float">
<label>TABLE 1</label>
<caption>
<p>Cofactor-dependent <italic>in vitro</italic> metabolic stability parameters of GRL0617.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" align="center">Compound</th>
<th align="center">Half-life</th>
<th align="center">Intrinsic clearance (<italic>in vitro</italic>)</th>
<th align="center">Intrinsic clearance (<italic>in vivo</italic>)</th>
<th align="center">Hepatic clearance</th>
</tr>
<tr>
<th align="center">(min)</th>
<th align="center">Cl<sub>int</sub> (&#x3bc;L/min/mg protein)</th>
<th align="center">CL<sub>int</sub> (mL/min/kg)</th>
<th align="center">CL<sub>h</sub> (mL/min/kg)</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="center">NADPH</td>
<td align="center">26.4</td>
<td align="center">26.3</td>
<td align="center">27.0</td>
<td align="center">11.7</td>
</tr>
<tr>
<td align="center">NADPH &#x2b; UDPGA</td>
<td align="center">29.5</td>
<td align="center">23.5</td>
<td align="center">24.1</td>
<td align="center">11.1</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>The metabolic stability parameters were calculated according to the well-stirred model approach.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>Generation of M1 (hydroxylation) and M3 (desaturation, -H2), the major metabolites of GRL0617 and HY-17542, was represented in <xref ref-type="fig" rid="F3">Figures 3B, C</xref>. All other generated metabolites area was less than 1% of the parent area/internal standard area. There is no detectable metabolite in HLMs incubated with UDPGA only, thus for the comparisons of the metabolic contribution of CYPs, 1&#x2013;50&#xa0;&#xb5;M of GRL0617 was incubated in the same condition with HLM with NADPH only. The relative GRL0617 concentration and formation of M1 and M3 were presented in <xref ref-type="fig" rid="F3">Figures 3D&#x2013;F</xref>, respectively. M1 and M3 were the dominant metabolites of GRL0617, which is similar with the results from HLM incubated with 1&#xa0;&#xb5;M GRL0617. The remaining % of GRL0617 were decreased by increased GRL0617 concentration. The M1 formation in 1&#xa0;&#xb5;M of GRL0617 was 7.2 &#xb1; 0.6% at 30&#xa0;min and decreased to 5.7 &#xb1; 0.2% at 45&#xa0;min and 4.9 &#xb1; 0.2% at 60&#xa0;min incubation, which was attenuated by increasing concentrations of GRL0617 (<xref ref-type="fig" rid="F3">Figure 3E</xref>) M3 formation showed an increment to 45&#xa0;min in all incubated concentrations (<xref ref-type="fig" rid="F3">Figure 3F</xref>). The metabolic profiles of GRL0617 in HLM incubations containing NADPH and NADPH &#x2b; UDPGA are shown in <xref ref-type="fig" rid="F3">Figures 3G, H</xref>, respectively. HY-17542 underwent deacetylation rapidly in HLM incubated with or without NADPH (<xref ref-type="fig" rid="F4">Figures 4A, B</xref>). The calculated half-lives for NADPH-dependent metabolism and NADPH-independent degradation were 5.26 and 10.83&#xa0;min, respectively. We incubated HY-17542 without HLM and NADPH to 180&#xa0;min in the phosphate buffer condition. HY-17542 was not significantly changed in 180&#xa0;min incubation (0&#xa0;min control 100 &#xb1; 1.08%, and 180&#xa0;min incubation 99.89 &#xb1; 7.69, <italic>n</italic> &#x3d; 3). CES 1 or 2 was possible enzyme responsible for the deacetylation. Recombinant CES1 did not affect HY-17542 concentration, but CES2 slightly decreased HY-17542 concentration to 88.01 &#xb1; 10.5% and produced GRL0617 from HY-17542. HY-17542 metabolites in HLM incubated with NADPH are presented in <xref ref-type="fig" rid="F4">Figures 4C, D</xref>. M1 and M3 were also detected from HY-17542 in a time-dependent manner. <xref ref-type="fig" rid="F4">Figure 4E</xref> shows a representative chromatogram of GRL0617 and its metabolites in HLM with NADPH from QTOF MS analysis.</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption>
<p>Metabolic stability of HY-17542 in HLMs. <bold>(A)</bold> 1&#xa0;&#xb5;M of HY-17542 was incubated with HLMs in the presence or absence of NADPH and incubated with recombinant CES 1 or CES2. <bold>(B)</bold> GRL0617 generation rates in incubations of HY-17542 with HLMs in the presence or absence of NADPH and with CES1 and CES2. <bold>(C)</bold> Formation of M1 in the incubation of 1&#xa0;&#xb5;M of HY-17542 in HLMs with NADPH. <bold>(D)</bold> Formation of M3 in the incubation of 1&#xa0;&#xb5;M of HY-17542 in HLMs with NADPH. Data are presented as mean &#xb1; SD from three independent samples (<italic>n</italic> &#x3d; 3). <bold>(E)</bold> Representative chromatogram of GRL0617 and its metabolites in the presence of a NADPH-generating system from QTOF MS analysis.</p>
</caption>
<graphic xlink:href="fphar-14-1067408-g004.tif"/>
</fig>
<p>M1 is hydroxylated at the para-amino toluene (also referred to as p-toluidine) side (<xref ref-type="fig" rid="F1">Figure 1</xref>), with a retention time of 5.28&#xa0;min. M1 displayed a hydroxylated fragment ion from the para-amino toluene side (m/z 167.0797) and a C<sub>12</sub>H<sub>11</sub>
<sup>&#x2b;</sup> fragment ion observed at m/z 155.0837 for GRL0617 (<xref ref-type="sec" rid="s10">Supplemental Figure S1A</xref>). A different fragmentation pattern was observed for M2, the other hydroxylated metabolite. The m/z 171.0768 (C<sub>12</sub>H<sub>11</sub>
<sup>&#x2b;</sup>) fragment ion corresponds to the hydroxylation of the naphthalene ring side (<xref ref-type="sec" rid="s10">Supplemental Figure S1B</xref>). The M3 metabolite has a fragment ion at m/z 149.068 (C<sub>8</sub>H<sub>9</sub>N<sub>2</sub>O<sup>&#x2b;</sup>), representing -H2 fragmentation of the para-amino toluene side and shared with the M1 metabolite at m/z 155.0836 (C<sub>12</sub>H<sub>11</sub>
<sup>&#x2b;</sup>), which is not changed naphthalene side ring fragment. M4 and M5 displayed the same hydroxylated fragment pattern as M1. The M1, M2, M3, M4, and M5 fragment patterns are presented in <xref ref-type="sec" rid="s10">Supplemental Figure S1</xref>. Glucuronidation metabolites of the hydroxylated M4 and M5 metabolites were detected at 5.19 and 5.41&#xa0;min, respectively.</p>
</sec>
<sec id="s3-2">
<title>3.2 Identification of CYPs involved in GRL0617 metabolism</title>
<p>Enzymes involved in NADPH-dependent GRL0617 metabolism were determined by incubating each human recombinant CYP enzyme with GRL0617 (1&#xa0;&#xb5;M) for 60&#xa0;min and analyzed using LC-QTOF HRMS (<xref ref-type="fig" rid="F5">Figure 5</xref>). Reaction phenotyping is the identification of isoforms involved in drug metabolism and is important for the decipherment of drug biotransformation pathways and understanding of possible drug-drug interactions. Metabolites detected for GRL0617 and HY-17542 are presented in <xref ref-type="table" rid="T2">Table 2</xref>. M6, M7, and M8 were also detected in recombinant CYP incubations.</p>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption>
<p>Metabolism of GRL0617 with recombinant human cytochrome P450 (CYP) enzymes. GRL0617 (1&#xa0;&#x3bc;M) was incubated with 50&#xa0;pmol/mL of each recombinant enzyme in the presence of a NADPH-generating system for 60&#xa0;min. Control values were determined in a mock recombinant assay and the peak areas were compared with the control for <bold>(A)</bold> GRL0617 and its metabolites, including <bold>(B)</bold> M1, <bold>(C)</bold> M2, <bold>(D)</bold> M3, <bold>(E)</bold> M6, <bold>(F)</bold> M7, and <bold>(G)</bold> M8. Data are presented as mean &#xb1; SD from three independent samples (<italic>n</italic> &#x3d; 3).</p>
</caption>
<graphic xlink:href="fphar-14-1067408-g005.tif"/>
</fig>
<table-wrap id="T2" position="float">
<label>TABLE 2</label>
<caption>
<p>LC-QTOF data for GRL0617, HY-17542, and their metabolites.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="left">No.</th>
<th align="left">Metabolic pathway</th>
<th align="center">rt (min)</th>
<th align="center">Measured [M &#x2b; H]<sup>&#x2b;</sup>
</th>
<th align="center">Formula</th>
<th align="center">Error (ppm)</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left"/>
<td align="left">HY-17542</td>
<td align="center">6.7</td>
<td align="center">347.1764</td>
<td align="center">C<sub>22</sub>H<sub>22</sub>N<sub>2</sub>O<sub>2</sub>
</td>
<td align="center">3.7</td>
</tr>
<tr>
<td align="left">M0</td>
<td align="left">GRL0617</td>
<td align="center">5.9</td>
<td align="center">305.1653</td>
<td align="center">C<sub>20</sub>H<sub>20</sub>N<sub>2</sub>O</td>
<td align="center">1.5</td>
</tr>
<tr>
<td align="left">M1</td>
<td align="left">hydroxylation</td>
<td align="center">5.3</td>
<td align="center">321.1598</td>
<td align="center">C<sub>20</sub>H<sub>20</sub>N<sub>2</sub>O<sub>2</sub>
</td>
<td align="center">0.3</td>
</tr>
<tr>
<td align="left">M2</td>
<td align="left">hydroxylation</td>
<td align="center">4.8</td>
<td align="center">321.1589</td>
<td align="center">C<sub>20</sub>H<sub>20</sub>N<sub>2</sub>O<sub>2</sub>
</td>
<td align="center">2.6</td>
</tr>
<tr>
<td align="left">M3</td>
<td align="left">desaturation (-H<sub>2</sub>)</td>
<td align="center">5.7</td>
<td align="center">303.1487</td>
<td align="center">C<sub>20</sub>H<sub>18</sub>N<sub>2</sub>O</td>
<td align="center">1.6</td>
</tr>
<tr>
<td align="left">M4</td>
<td align="left">monooxygenation with glucuronidation</td>
<td align="center">5.2</td>
<td align="center">497.191</td>
<td align="center">C<sub>26</sub>H<sub>28</sub>N<sub>2</sub>O<sub>8</sub>
</td>
<td align="center">1.7</td>
</tr>
<tr>
<td align="left">M5</td>
<td align="left">monooxygenation with glucuronidation</td>
<td align="center">5.4</td>
<td align="center">497.1922</td>
<td align="center">C<sub>26</sub>H<sub>28</sub>N<sub>2</sub>O<sub>8</sub>
</td>
<td align="center">0.7</td>
</tr>
<tr>
<td align="left">M6</td>
<td align="left">two monooxygenation</td>
<td align="center">4.8</td>
<td align="center">337.1543</td>
<td align="center">C<sub>20</sub>H<sub>20</sub>N<sub>2</sub>O<sub>3</sub>
</td>
<td align="center">1</td>
</tr>
<tr>
<td align="left">M7</td>
<td align="left">monooxygenation and desaturation (-H<sub>2</sub>)</td>
<td align="center">5.3</td>
<td align="center">319.1437</td>
<td align="center">C<sub>20</sub>H<sub>18</sub>N<sub>2</sub>O<sub>2</sub>
</td>
<td align="center">1.2</td>
</tr>
<tr>
<td align="left">M8</td>
<td align="left">two monooxygenation and desaturation (-H<sub>2</sub>)</td>
<td align="center">4.8</td>
<td align="center">335.1384</td>
<td align="center">C<sub>20</sub>H<sub>18</sub>N<sub>2</sub>O<sub>3</sub>
</td>
<td align="center">1.7</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>Abbreviations: rt &#x3d; retention time, ppm &#x3d; parts per million.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>GRL0617 levels decreased to 71.46% &#xb1; 3.1%, 9.48% &#xb1; 1.26%, and 4.96% &#xb1; 1.08% in incubations with recombinant CYP2D6, CYP3A4, and CYP3A5 enzymes, respectively (<xref ref-type="fig" rid="F5">Figure 5A</xref>). The incubation of GRL0617 with other CYP isoforms resulted in &#x3c;10% reductions. Control bactosome did not affect GRL0617 remaining concentration. These results indicate that CYP2D6, CYP3A4, and CYP3A5 are involved more significantly in GRL0617 metabolism than are other isoforms. M1 formation was mediated mainly by CYP3A4 and CYP3A5, and to a lesser extent by CYP2D6 and CYP1A2 (<xref ref-type="fig" rid="F5">Figure 5B</xref>). M2, the metabolite hydroxylated on the naphthalene ring side, was produced primarily with recombinant CYP2D6 enzymes. M3 is a desaturated metabolite (-2H) produced by incubation with CYP3A4 and CYP3A5, and to a lesser extent with CYP1A2 (<xref ref-type="fig" rid="F5">Figure 5D</xref>). Relatively small amounts of M6, M7, and M8 metabolites were detected in incubations with CYP2D6, CYP3A4, and CYP3A5 (<xref ref-type="fig" rid="F6">Figures 6E&#x2013;G</xref>). Given their low abundance, the MS/MS spectra of these metabolites were not acquired.</p>
<fig id="F6" position="float">
<label>FIGURE 6</label>
<caption>
<p>Effects of GRL0617 on the activities of <bold>(A)</bold> CYP1A2, <bold>(B)</bold> CYP2A6, <bold>(C)</bold> CYP2B6, <bold>(D)</bold> CYP2C8, <bold>(E)</bold> CYP2C9, <bold>(F)</bold> CYP219, <bold>(G)</bold> CYP2D6, <bold>(H)</bold> CYP2E1, <bold>(I)</bold> CYP3A4 (midazolam as a substrate), and <bold>(J)</bold> CYP3A4 (testosterone as a substrate) in pooled HLMs. Activity is expressed as the percentage of activity remaining as compared with a control sample containing no inhibitor (100%). Data are presented as mean &#xb1; SD from three independent samples (<italic>n</italic> &#x3d; 3).</p>
</caption>
<graphic xlink:href="fphar-14-1067408-g006.tif"/>
</fig>
<p>The contribution of individual CYP isoforms to GRL0617 biotransformation in HLM was evaluated using Silensomes (<xref ref-type="bibr" rid="B19">Parmentier et al., 2017</xref>; <xref ref-type="bibr" rid="B20">Parmentier et al., 2019</xref>). Metabolic stability of GRL 0617 and formation of M1 and M3 were evaluated using Silensome control, Silensome CYP2D6 and Silensome CYP3A4 incubated with 1 or 10&#xa0;&#xb5;M GRL 0617 in the presence of NADPH. Other metabolites were detected less than 1% of parent. Both M1 and M3 formation was significantly reduced in Silensome CYP2D6 and CYP3A4, but CYP3A4 contribution for M1 and M3 formation was higher than CYP2D6 (<xref ref-type="sec" rid="s10">Supplemental Figure S2</xref>). Enzyme kinetic analysis was performed in 50&#xa0;pmol/mL recombinant CYP2D6, CYP3A4, and CYP3A5 with various concentrations of GRL0617 for 10&#xa0;min (<xref ref-type="sec" rid="s10">Supplemental Figure S3</xref>). The calculated parameters were presented in <xref ref-type="table" rid="T3">Table 3</xref>. CYP3A5 showed higher K<sub>cat</sub>/K<sub>m</sub> for M1 formation than CYP3A4, but for M3 formation CYP3A4 showed higher K<sub>cat</sub>/K<sub>m</sub> value. CYP2D6 played an exclusive role in the formation of M2, but the reactions were not saturated in the concentration range used in this study and thus, the calculated K<sub>cat</sub>, and K<sub>m</sub> were out of the experiment condition.</p>
<table-wrap id="T3" position="float">
<label>TABLE 3</label>
<caption>
<p>Kinetic parameters for the reactions of GRL0617 metabolism were determined using recombinants CYP2D6, CYP3A4, and CYP3A5.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" align="left">&#xa0;</th>
<th rowspan="2" colspan="2" align="center">Kinetic parameters</th>
<th colspan="3" align="center">Metabolites</th>
</tr>
<tr>
<th align="center">M1</th>
<th align="center">M2</th>
<th align="center">M3</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td rowspan="3" colspan="2" align="center">CYP2D6</td>
<td align="center">K<sub>m</sub> (&#xb5;M)</td>
<td align="center">85.1 (69.4&#x2013;107.8)</td>
<td align="center">N/A</td>
<td align="center">N/A</td>
</tr>
<tr>
<td align="center">k<sub>cat</sub> (intensity ratio/min/pmol CYP2D6)</td>
<td align="center">1.4 (1.2&#x2013;1.7)</td>
<td align="center">N/A</td>
<td align="center">N/A</td>
</tr>
<tr>
<td align="center">k<sub>cat</sub>/K<sub>m</sub> (intensity ratio/min/pmol/&#xb5;M)</td>
<td align="center">1.7 &#xd7; 10<sup>&#x2212;2</sup>
</td>
<td align="center">N/A</td>
<td align="center">N/A</td>
</tr>
<tr>
<td rowspan="3" colspan="2" align="center">CYP3A4</td>
<td align="center">K<sub>m</sub> (&#xb5;M)</td>
<td align="center">18.2 (14.8&#x2013;22.7)</td>
<td align="center">N/A</td>
<td align="center">14.8 (12.3&#x2013;18.0)</td>
</tr>
<tr>
<td align="center">k<sub>cat</sub> (intensity ratio/min/pmol CYP3A4)</td>
<td align="center">1.7 (1.6&#x2013;1.9)</td>
<td align="center">N/A</td>
<td align="center">0.36 (0.34&#x2013;0.39)</td>
</tr>
<tr>
<td align="center">k<sub>cat</sub>/K<sub>m</sub> (intensity ratio/min/pmol CYP3A4/&#xb5;M)</td>
<td align="center">9.6 &#xd7; 10<sup>&#x2212;2</sup>
</td>
<td align="center">N/A</td>
<td align="center">2.4 &#xd7; 10<sup>&#x2212;2</sup>
</td>
</tr>
<tr>
<td rowspan="3" colspan="2" align="center">CYP3A5</td>
<td align="center">K<sub>m</sub> (&#xb5;M)</td>
<td align="center">8.5 (7.6&#x2013;9.5)</td>
<td align="center">N/A</td>
<td align="center">8.5 (11.6&#x2013;16.7)</td>
</tr>
<tr>
<td align="center">k<sub>cat</sub> (intensity ratio/min/pmol CYP3A5)</td>
<td align="center">1.4 (12.43&#x2013;16.7)</td>
<td align="center">N/A</td>
<td align="center">0.22 (0.20&#x2013;0.23)</td>
</tr>
<tr>
<td align="center">k<sub>cat</sub>/K<sub>m</sub> (intensity ratio/min/pmol CYP3A5/&#xb5;M)</td>
<td align="center">1.7 &#xd7; 10<sup>&#x2212;1</sup>
</td>
<td align="center">N/A</td>
<td align="center">1.6 &#xd7; 10<sup>&#x2212;2</sup>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>GRL0617 (0, 0.22, 0.62, 1.85, 5.56, 16.67, and 50&#xa0;&#xb5;M) was incubated with each recombinant CYP, enzyme in the presence of an NADPH, generating system for 10&#xa0;min. The apparent Km and Kcat values were calculated by non-linear regression using the Michaelis-Menten equation. Data are expressed as means &#xb1; SD, for three independent samples. Values in parentheses represent 95% confidential intervals. N/A, not applicable.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>In addition, the contribution of specific isoform using Silensomes were evaluated, and calculated parameters were shown in <xref ref-type="sec" rid="s10">Supplemental Figure S4</xref> and <xref ref-type="table" rid="T4">Table 4</xref>. Half-life of GRL0617 in the Silensome control, Silensome CYP2D6 or Silensome CYP3A4 was calculated as 17.4, 22.3, and 85.1&#xa0;min, respectively. The contribution of specific CYP 3A4 or CYP2D6 was calculated to be 79.6% or 21.8%, respectively, using equation as equation below. Calculated % CYP isoform contribution &#x3d; CLint<sub>control</sub>&#x2212;Clint<sub>INH</sub> &#x2044; CLint<sub>control</sub> (<xref ref-type="bibr" rid="B4">Bohnert et al., 2016</xref>).</p>
<table-wrap id="T4" position="float">
<label>TABLE 4</label>
<caption>
<p>Contribution of CYP2D6 and CYP3A4 to GRL0617 <italic>in vitro</italic> metabolism in Silensomes.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" align="center">Factor</th>
<th align="center">Half-life</th>
<th align="center">Intrinsic clearance (<italic>in vitro</italic>)</th>
<th align="center">Contribution</th>
</tr>
<tr>
<th align="center">(min)</th>
<th align="center">Cl<sub>int</sub> (&#x3bc;L/min/mg protein)</th>
<th align="center">(%)</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Silensome control</td>
<td align="center">17.4</td>
<td align="center">39.8</td>
<td align="center">100</td>
</tr>
<tr>
<td align="left">Silensome CYP2D6</td>
<td align="center">22.3</td>
<td align="center">31.2</td>
<td align="center">21.8</td>
</tr>
<tr>
<td align="left">Silensome CYP3A4/3A5</td>
<td align="center">85.1</td>
<td align="center">8.14</td>
<td align="center">79.6</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s3-3">
<title>3.3 Effect of GRL0617 on CYP isoform activity in HLMs</title>
<p>An LC-MS/MS&#x2013;based CYP inhibition assay was performed using CYP substrates (<xref ref-type="bibr" rid="B14">Lee and Kim, 2013</xref>). The ability of GRL0617 to inhibit the formation of metabolites by nine CYP isoforms (CYP1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1, and 3A4) was evaluated using pooled HLMs and substrate cocktails (<xref ref-type="fig" rid="F6">Figure 6</xref>). Experimental GRL0617 IC<sub>50</sub> values were determined from seven-point concentration-response curves. Ketoconazole was used as a positive control with strong CYP3A4 inhibition ability and an IC<sub>50</sub> value within the reference range (data not shown).</p>
<p>Tolbutamide 4-hydroxylation formation was used to determine CYP2C9 activity and midazolam 1-hydroxylation and testosterone 6&#x3b2;-hydroxylation formation were taken to indicate CYP3A4 activity; both activities were markedly inhibited (<xref ref-type="fig" rid="F6">Figures 6E, I, J</xref>). GRL0617 IC<sub>50</sub> values with 95% confidence intervals (CIs) were 7.6&#xa0;&#x3bc;M (6.3&#x2013;9.2&#xa0;&#x3bc;M) for CYP2C9, 10.9&#xa0;&#x3bc;M (8.7&#x2013;13.6&#xa0;&#x3bc;M) for CYP3A4 (midazolam), and 8.0&#xa0;&#x3bc;M (6.4&#x2013;10.1&#xa0;&#x3bc;M) for CYP3A4 (testosterone). GRL0617 weakly inhibited CYP1A2 [IC<sub>50</sub> &#x3d; 59.6&#xa0;&#x3bc;M (42.9&#x2013;82.7&#xa0;&#x3bc;M)], CYP2B6 [IC<sub>50</sub> &#x3d; 22.6&#xa0;&#x3bc;M (11.0&#x2013;46.2&#xa0;&#x3bc;M)], and CYP2C19 [IC<sub>50</sub> &#x3d; 27.5&#xa0;&#x3bc;M (22.4&#x2013;33.8&#xa0;&#x3bc;M)] relative to CYP2C9 and CYP3A4. GRL0617 inhibited 2A6, 2D6, and CYP2E1 at concentrations &#x2265; 50&#xa0;&#x3bc;M (<xref ref-type="fig" rid="F6">Figures 6B, G, H</xref>).</p>
<p>The time-dependent inhibition of CYP2C9 and CYP3A4 by GRL0617 showing relatively strong inhibitory effect than other isoforms were evaluated using IC<sub>50</sub> shifts between microsomes incubated with and without NADPH for 30&#xa0;min pre-incubation. Shifts of GRL0617 IC<sub>50</sub> values against CYP2C9 using 100&#xa0;&#x3bc;M tolbutamide as a substrate and CYP3A4 using 5&#xa0;&#x3bc;M midazolam and 50&#xa0;&#x3bc;M testosterone were determined from seven-points concentration-response curves. The IC<sub>50</sub> shifts of GRL0617 on CYP2C9, CYP3A4 (midazolam), and CYP3A4 (testosterone) were 3.38, 10.8, and 1.54, respectively. The results suggest that the GRL0617-induced CYP inhibition may be time-dependent.</p>
</sec>
</sec>
<sec sec-type="discussion" id="s4">
<title>4 Discussion</title>
<p>In January 2022, more than 660 million people had confirmed COVID-19; more than 6.7 million COVID-19&#x2013;related deaths and 13 million vaccinated individuals were reported (<xref ref-type="bibr" rid="B28">WHO, 2023</xref>). Paxlovid (nirmatrelvir/ritonavir) and Lagevrio (molnupiravir) are approved for the treatment of COVID-19. Nirmatrelvir is a SARS-CoV-2 main protease (also known as 3CL protease) inhibitor, and molnupiravir promotes widespread mutation during the replication of viral RNA by RNA-directed RNA polymerase (<xref ref-type="bibr" rid="B11">Kabinger et al., 2021</xref>). Molnupiravir has lower efficacy to treat COVID-19 than Paxlovid (<xref ref-type="bibr" rid="B24">Saravolatz et al., 2022</xref>). With the emergence of numerous SARS-CoV-2 variants, concern about acquired viral resistance to nirmatrelvir has arisen (<xref ref-type="bibr" rid="B9">Iketani et al., 2022</xref>; <xref ref-type="bibr" rid="B29">Yang et al., 2022</xref>). Thus, additional targeted inhibitors are required for SARS-CoV-2 infection treatment. In 2008, GRL0617 was found to be a Plpro inhibitor (<xref ref-type="bibr" rid="B23">Ratia et al., 2008</xref>); subsequent structural studies have led to the identification of new Plpro inhibitors with improved anti&#x2013;SARS-CoV-2 potency (<xref ref-type="bibr" rid="B5">Elseginy and Anwar, 2021</xref>; <xref ref-type="bibr" rid="B22">Rao et al., 2022</xref>; <xref ref-type="bibr" rid="B25">Shen et al., 2022</xref>). The metabolic stability of these analog compounds has been reported only in mouse microsomes (<xref ref-type="bibr" rid="B1">B&#xe1;ez-Santos et al., 2014</xref>), and as <italic>in silico</italic> predictions (<xref ref-type="bibr" rid="B18">Parmar et al., 2021</xref>; <xref ref-type="bibr" rid="B22">Rao et al., 2022</xref>). <italic>In vitro</italic> experimental investigations of the metabolites, reaction phenotyping, and CYP inhibition have not been reported for GRL0617.</p>
<p>Hepatic drug metabolism can produce metabolites whose pharmacological activities differ from those of the parent drugs. <italic>In vitro</italic> assays have shown that GRL0617 acts more efficiently against SARS-CoV and SARS-Cov-2, with an IC<sub>50</sub> value approximately five-fold lower than that of HY-17542 (<xref ref-type="bibr" rid="B23">Ratia et al., 2008</xref>; <xref ref-type="bibr" rid="B6">Fu et al., 2021</xref>). HY-17542 undergoes rapid deacetylation to GRL0617, and thus can be used as a GRL0617 prodrug as long as it has more advantageous physicochemical properties than does GRL0617. The halflife of GRL0617 during phase I metabolism was &#x3c;30&#xa0;min, indicating very high clearance of GRL0167 and HY-17542. To maintain sufficient plasma concentrations, additional pharmacokinetic studies and the development of new GRL0617 analogs should be undertaken.</p>
<p>The <italic>in silico</italic> prediction tool pkCSM indicated that GRL0617 is a CYP3A4 substrate, but not a CYP2D6 substrate (<xref ref-type="bibr" rid="B22">Rao et al., 2022</xref>). GRL0617 was also predicted to inhibit CYP1A2, CYP2C9, CYP2C19, and CYP3A4, but not CYP2D6 (<xref ref-type="bibr" rid="B22">Rao et al., 2022</xref>). In the present study, CYP3A4, CYP3A5, and CYP2D6 contributed to the elimination of GRL0617 in HLM incubations. We determined contribution of CYP3A4 and CYP2D6 in using Silensome and CYP3A4 has bigger contribution than CYP2D6 for M1 and M3 metabolism. As GRL0617 showed the time-dependent manner of CYP3A4 inhibition, which is also involved in its metabolism, long-term treatment may have the effect of further increasing GRL0617 concentrations in plasma through CYP3A4 inhibition. Further precise kinetic experiments with specific reaction with quantification is required for pharmacokinetic prediction and the estimation of drug&#x2013;drug interactions.</p>
<p>CYP3A4/5 metabolizes various chemicals composed of large, lipophilic molecules with diverse structures, and &#x3e;50% of all prescribed drugs undergo CYP3A4 metabolism (<xref ref-type="bibr" rid="B30">Zanger and Schwab, 2013</xref>). CYP3A4-related drug interaction studies are critical for the prediction of drug&#x2013;drug interactions in the clinic (<xref ref-type="bibr" rid="B21">Prueksaritanont et al., 2013</xref>). The current study showed that GRL0617 concentrations were lower in CYP3A5 incubations than in other CYP isoforms, and M1 formation was higher CYP3A5 than CYP3A4. In addition, Silensome CYP3A4 was prepared using pre-treatment with azamulin that also inhibits CYP3A5 (<xref ref-type="bibr" rid="B27">Stresser et al., 2004</xref>; <xref ref-type="bibr" rid="B19">Parmentier et al., 2017</xref>). Thus, Silensome 3A4 represented contribution of both CYP3A4 and CYP3A5, compared with control Silensome. CYP3A5 expression in the liver differs between Africans/African Americans and Caucasians. Like the immune suppressor tacrolimus, CYP3A5 expressor genotypes (CYP3A5&#x2a;1/&#x2a; and &#x2a;1/&#x2a;3) may contribute significantly to GRL0617 metabolism in individuals with low CYP3A4 expression (<xref ref-type="bibr" rid="B12">Lamba et al., 2012</xref>). CYP2D6 is a highly polymorphic gene involved in drug metabolism (<xref ref-type="bibr" rid="B10">Ingelman-Sundberg et al., 2007</xref>). Its ultrarapid metabolizer phenotypes, such as those possessing copy number variants CYP2D6&#x2a;1 and CYP2D6&#x2a;2, may also contribute significantly to GRL0617 metabolism. Indeed, CYP2D6 metabolized the naphthalene side ring through hydroxylation, which is not linked to M1&#x2013;M3 dehydration.</p>
<p>GRL0617 hydroxylation was observed on the para-amino toluene and ethyl-naphthalene side chains. Desaturation (-H2) of the para-amino toluene side chain might produce an imine methide, a reactive and toxic metabolite. The aromatic amine moiety on GRL0617 raises concerns about toxicity, including carcinogenesis and erythrocyte lysis (<xref ref-type="bibr" rid="B15">Limban et al., 2018</xref>). Piperidine-4-carboxamide scaffold-substituted compounds based on GRL0617 were developed to improve efficacy against SARS-CoV; however, the compounds were metabolically unstable in mouse liver microsomes (<xref ref-type="bibr" rid="B1">B&#xe1;ez-Santos et al., 2014</xref>). These metabolic features should be considered with the development of GRL0617 derivative compounds.</p>
<p>The proposed metabolism of GRL0617 and HY-17542 is presented in <xref ref-type="fig" rid="F7">Figure 7</xref>. In summary, we suggest that CYP enzymes play major roles in hepatic GRL0617 and HY-17542 metabolism. HY-17542, an acetylated analog of GRL0617, is metabolized rapidly to GRL0617. Our experiments with recombinant enzymes showed that CYP3A4, CYP3A5, and CYP2D6 are involved in GRL0617 elimination and the formation of hydroxylated metabolites M1, M2, and M3. CYP3A4/5 played a dominant role in the hydroxylation and -H2 oxidation of para-amino toluene groups. GRL0617 also inhibits CYP3A4 and CYP2C9. Further research is required to assess GRL0617s toxicity, mechanism of CYP inhibition and clearance in hepatocytes.</p>
<fig id="F7" position="float">
<label>FIGURE 7</label>
<caption>
<p>Proposed metabolic pathways of GRL0617 and HY-17542 in the liver.</p>
</caption>
<graphic xlink:href="fphar-14-1067408-g007.tif"/>
</fig>
</sec>
</body>
<back>
<sec sec-type="data-availability" id="s5">
<title>Data availability statement</title>
<p>The raw data supporting the conclusion of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s6">
<title>Author contributions</title>
<p>Conceptualization, CR and SK; Methodology, HC and CR; Validation, CR, HC, and SK; Formal analysis, HC and CR; Writing-original draft, HC and CR; Writing-review and editing, HC, YK, J-WC, MM, SK, and CR. All authors contributed to the study and approved the final manuscript.</p>
</sec>
<sec id="s7">
<title>Funding</title>
<p>It was supported by the Korea Environmental Industry and Technology Institute through the Core Technology Development Project for Environmental Diseases Prevention and Management (2021003310001), funded by the Korea Ministry of Environment.</p>
</sec>
<ack>
<p>This research was part of CIAO&#x2014;Modelling the Pathogenesis of COVID-19 using the Adverse Outcome Pathway Framework.</p>
</ack>
<sec sec-type="COI-statement" id="s8">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s9">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s10">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fphar.2023.1067408/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fphar.2023.1067408/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet1.pdf" id="SM1" mimetype="application/pdf" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>B&#xe1;ez-Santos</surname>
<given-names>Y. M.</given-names>
</name>
<name>
<surname>Barraza</surname>
<given-names>S. J.</given-names>
</name>
<name>
<surname>Wilson</surname>
<given-names>M. W.</given-names>
</name>
<name>
<surname>Agius</surname>
<given-names>M. P.</given-names>
</name>
<name>
<surname>Mielech</surname>
<given-names>A. M.</given-names>
</name>
<name>
<surname>Davis</surname>
<given-names>N. M.</given-names>
</name>
<etal/>
</person-group> (<year>2014</year>). <article-title>X-Ray structural and biological evaluation of a series of potent and highly selective inhibitors of human coronavirus papain-like proteases</article-title>. <source>J. Med. Chem.</source> <volume>57</volume> (<issue>6</issue>), <fpage>2393</fpage>&#x2013;<lpage>2412</lpage>. <pub-id pub-id-type="doi">10.1021/jm401712t</pub-id>
</citation>
</ref>
<ref id="B2">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Baranczewski</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Sta&#x144;czak</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Sundberg</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Svensson</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Wallin</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Jansson</surname>
<given-names>J.</given-names>
</name>
<etal/>
</person-group> (<year>2006</year>). <article-title>Introduction to <italic>in vitro</italic> estimation of metabolic stability and drug interactions of new chemical entities in drug discovery and development</article-title>. <source>Pharmacol. Rep.</source> <volume>58</volume> (<issue>4</issue>), <fpage>453</fpage>&#x2013;<lpage>472</lpage>.</citation>
</ref>
<ref id="B3">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Berry</surname>
<given-names>L. M.</given-names>
</name>
<name>
<surname>Zhao</surname>
<given-names>Z.</given-names>
</name>
</person-group> (<year>2008</year>). <article-title>An examination of IC50 and IC50-shift experiments in assessing time-dependent inhibition of CYP3A4, CYP2D6 and CYP2C9 in human liver microsomes</article-title>. <source>Drug Metab. Lett.</source> <volume>2</volume> (<issue>1</issue>), <fpage>51</fpage>&#x2013;<lpage>59</lpage>. <pub-id pub-id-type="doi">10.2174/187231208783478407</pub-id>
</citation>
</ref>
<ref id="B4">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bohnert</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Patel</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Templeton</surname>
<given-names>I.</given-names>
</name>
<name>
<surname>Chen</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Lu</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Lai</surname>
<given-names>G.</given-names>
</name>
<etal/>
</person-group> (<year>2016</year>). <article-title>Evaluation of a new molecular entity as a victim of metabolic drug-drug interactions-an industry perspective</article-title>. <source>Drug Metab. Dispos.</source> <volume>44</volume> (<issue>8</issue>), <fpage>1399</fpage>&#x2013;<lpage>1423</lpage>. <pub-id pub-id-type="doi">10.1124/dmd.115.069096</pub-id>
</citation>
</ref>
<ref id="B5">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Elseginy</surname>
<given-names>S. A.</given-names>
</name>
<name>
<surname>Anwar</surname>
<given-names>M. M.</given-names>
</name>
</person-group> (<year>2021</year>). <article-title>
<italic>In silico</italic> analysis of SARS-CoV-2 papain-like protease potential inhibitors</article-title>. <source>RSC Adv.</source> <volume>11</volume> (<issue>61</issue>), <fpage>38616</fpage>&#x2013;<lpage>38631</lpage>. <pub-id pub-id-type="doi">10.1039/D1RA07845C</pub-id>
</citation>
</ref>
<ref id="B6">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Fu</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Huang</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Tang</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Ye</surname>
<given-names>Y.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>The complex structure of GRL0617 and SARS-CoV-2 PLpro reveals a hot spot for antiviral drug discovery</article-title>. <source>Nat. Commun.</source> <volume>12</volume> (<issue>1</issue>), <fpage>488</fpage>. <pub-id pub-id-type="doi">10.1038/s41467-020-20718-8</pub-id>
</citation>
</ref>
<ref id="B7">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ghosh</surname>
<given-names>A. K.</given-names>
</name>
<name>
<surname>Takayama</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Aubin</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Ratia</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Chaudhuri</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Baez</surname>
<given-names>Y.</given-names>
</name>
<etal/>
</person-group> (<year>2009</year>). <article-title>Structure-based design, synthesis, and biological evaluation of a series of novel and reversible inhibitors for the severe acute respiratory Syndrome&#x2212;Coronavirus papain-like protease</article-title>. <source>J. Med. Chem.</source> <volume>52</volume> (<issue>16</issue>), <fpage>5228</fpage>&#x2013;<lpage>5240</lpage>. <pub-id pub-id-type="doi">10.1021/jm900611t</pub-id>
</citation>
</ref>
<ref id="B8">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ghosh</surname>
<given-names>A. K.</given-names>
</name>
<name>
<surname>Takayama</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Rao</surname>
<given-names>K. V.</given-names>
</name>
<name>
<surname>Ratia</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Chaudhuri</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Mulhearn</surname>
<given-names>D. C.</given-names>
</name>
<etal/>
</person-group> (<year>2010</year>). <article-title>Severe acute respiratory syndrome coronavirus papain-like novel protease inhibitors: Design, synthesis, Protein&#x2212;Ligand X-ray structure and biological evaluation</article-title>. <source>J. Med. Chem.</source> <volume>53</volume> (<issue>13</issue>), <fpage>4968</fpage>&#x2013;<lpage>4979</lpage>. <pub-id pub-id-type="doi">10.1021/jm1004489</pub-id>
</citation>
</ref>
<ref id="B9">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Iketani</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Mohri</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Culbertson</surname>
<given-names>B.</given-names>
</name>
<name>
<surname>Hong</surname>
<given-names>S. J.</given-names>
</name>
<name>
<surname>Duan</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Luck</surname>
<given-names>M. I.</given-names>
</name>
<etal/>
</person-group> (<year>2022</year>). <article-title>Multiple pathways for SARS-CoV-2 resistance to nirmatrelvir</article-title>. <comment>bioRxiv</comment>. <pub-id pub-id-type="doi">10.1101/2022.08.07.499047</pub-id>
</citation>
</ref>
<ref id="B10">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ingelman-Sundberg</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Sim</surname>
<given-names>S. C.</given-names>
</name>
<name>
<surname>Gomez</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Rodriguez-Antona</surname>
<given-names>C.</given-names>
</name>
</person-group> (<year>2007</year>). <article-title>Influence of cytochrome P450 polymorphisms on drug therapies: Pharmacogenetic, pharmacoepigenetic and clinical aspects</article-title>. <source>Pharmacol. Ther.</source> <volume>116</volume> (<issue>3</issue>), <fpage>496</fpage>&#x2013;<lpage>526</lpage>. <pub-id pub-id-type="doi">10.1016/j.pharmthera.2007.09.004</pub-id>
</citation>
</ref>
<ref id="B11">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kabinger</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Stiller</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Schmitzov&#xe1;</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Dienemann</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Kokic</surname>
<given-names>G.</given-names>
</name>
<name>
<surname>Hillen</surname>
<given-names>H. S.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>Mechanism of molnupiravir-induced SARS-CoV-2 mutagenesis</article-title>. <source>Nat. Struct. Mol. Biol.</source> <volume>28</volume> (<issue>9</issue>), <fpage>740</fpage>&#x2013;<lpage>746</lpage>. <pub-id pub-id-type="doi">10.1038/s41594-021-00651-0</pub-id>
</citation>
</ref>
<ref id="B12">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lamba</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Hebert</surname>
<given-names>J. M.</given-names>
</name>
<name>
<surname>Schuetz</surname>
<given-names>E. G.</given-names>
</name>
<name>
<surname>Klein</surname>
<given-names>T. E.</given-names>
</name>
<name>
<surname>Altman</surname>
<given-names>R. B.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>PharmGKB summary: Very important pharmacogene information for CYP3A5</article-title>. <source>Pharmacogenet. Genomics</source> <volume>22</volume> (<issue>7</issue>), <fpage>555</fpage>&#x2013;<lpage>558</lpage>. <pub-id pub-id-type="doi">10.1097/FPC.0b013e328351d47f</pub-id>
</citation>
</ref>
<ref id="B13">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lee</surname>
<given-names>J. Y.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>S. Y.</given-names>
</name>
<name>
<surname>Oh</surname>
<given-names>S. J.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>K. H.</given-names>
</name>
<name>
<surname>Jung</surname>
<given-names>Y. S.</given-names>
</name>
<name>
<surname>Kim</surname>
<given-names>S. K.</given-names>
</name>
</person-group> (<year>2012</year>). <article-title>Assessment of drug-drug interactions caused by metabolism-dependent cytochrome P450 inhibition</article-title>. <source>Chem. Biol. Interact.</source> <volume>198</volume> (<issue>1-3</issue>), <fpage>49</fpage>&#x2013;<lpage>56</lpage>. <pub-id pub-id-type="doi">10.1016/j.cbi.2012.05.007</pub-id>
</citation>
</ref>
<ref id="B14">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lee</surname>
<given-names>K. S.</given-names>
</name>
<name>
<surname>Kim</surname>
<given-names>S. K.</given-names>
</name>
</person-group> (<year>2013</year>). <article-title>Direct and metabolism-dependent cytochrome P450 inhibition assays for evaluating drug-drug interactions</article-title>. <source>J. Appl. Toxicol.</source> <volume>33</volume> (<issue>2</issue>), <fpage>100</fpage>&#x2013;<lpage>108</lpage>. <pub-id pub-id-type="doi">10.1002/jat.1720</pub-id>
</citation>
</ref>
<ref id="B15">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Limban</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Nu&#x163;&#x103;</surname>
<given-names>D. C.</given-names>
</name>
<name>
<surname>Chiri&#x163;&#x103;</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Negre&#x219;</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Arsene</surname>
<given-names>A. L.</given-names>
</name>
<name>
<surname>Goumenou</surname>
<given-names>M.</given-names>
</name>
<etal/>
</person-group> (<year>2018</year>). <article-title>The use of structural alerts to avoid the toxicity of pharmaceuticals</article-title>. <source>Toxicol. Rep.</source> <volume>5</volume>, <fpage>943</fpage>&#x2013;<lpage>953</lpage>. <pub-id pub-id-type="doi">10.1016/j.toxrep.2018.08.017</pub-id>
</citation>
</ref>
<ref id="B16">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Pang</surname>
<given-names>K. S.</given-names>
</name>
<name>
<surname>Rowland</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>1977</year>). <article-title>Hepatic clearance of drugs. I. Theoretical considerations of a "well-stirred" model and a "parallel tube" model. Influence of hepatic blood flow, plasma and blood cell binding, and the hepatocellular enzymatic activity on hepatic drug clearance</article-title>. <source>J. Pharmacokinet. Biopharm.</source> <volume>5</volume> (<issue>6</issue>), <fpage>625</fpage>&#x2013;<lpage>653</lpage>. <pub-id pub-id-type="doi">10.1007/bf01059688</pub-id>
</citation>
</ref>
<ref id="B17">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Parkinson</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Kazmi</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Buckley</surname>
<given-names>D. B.</given-names>
</name>
<name>
<surname>Yerino</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Paris</surname>
<given-names>B. L.</given-names>
</name>
<name>
<surname>Holsapple</surname>
<given-names>J.</given-names>
</name>
<etal/>
</person-group> (<year>2011</year>). <article-title>An evaluation of the dilution method for identifying metabolism-dependent inhibitors of cytochrome P450 enzymes</article-title>. <source>Drug Metab. Dispos.</source> <volume>39</volume> (<issue>8</issue>), <fpage>1370</fpage>&#x2013;<lpage>1387</lpage>. <pub-id pub-id-type="doi">10.1124/dmd.111.038596</pub-id>
</citation>
</ref>
<ref id="B18">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Parmar</surname>
<given-names>D. R.</given-names>
</name>
<name>
<surname>Soni</surname>
<given-names>J. Y.</given-names>
</name>
<name>
<surname>Guduru</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Rayani</surname>
<given-names>R. H.</given-names>
</name>
<name>
<surname>Kusurkar</surname>
<given-names>R. V.</given-names>
</name>
<name>
<surname>Vala</surname>
<given-names>A. G.</given-names>
</name>
<etal/>
</person-group> (<year>2021</year>). <article-title>Discovery of new anticancer thiourea-azetidine hybrids: Design, synthesis, <italic>in vitro</italic> antiproliferative, SAR, <italic>in silico</italic> molecular docking against VEGFR-2, ADMET, toxicity, and DFT studies</article-title>. <source>Bioorg. Chem.</source> <volume>115</volume>, <fpage>105206</fpage>. <pub-id pub-id-type="doi">10.1016/j.bioorg.2021.105206</pub-id>
</citation>
</ref>
<ref id="B19">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Parmentier</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Pothier</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Delmas</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Caradec</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Trancart</surname>
<given-names>M. M.</given-names>
</name>
<name>
<surname>Guillet</surname>
<given-names>F.</given-names>
</name>
<etal/>
</person-group> (<year>2017</year>). <article-title>Direct and quantitative evaluation of the human CYP3A4 contribution (f(m)) to drug clearance using the <italic>in vitro</italic> SILENSOMES model</article-title>. <source>Xenobiotica</source> <volume>47</volume> (<issue>7</issue>), <fpage>562</fpage>&#x2013;<lpage>575</lpage>. <pub-id pub-id-type="doi">10.1080/00498254.2016.1208854</pub-id>
</citation>
</ref>
<ref id="B20">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Parmentier</surname>
<given-names>Y.</given-names>
</name>
<name>
<surname>Pothier</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Hewitt</surname>
<given-names>N.</given-names>
</name>
<name>
<surname>Vincent</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Caradec</surname>
<given-names>F.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>J.</given-names>
</name>
<etal/>
</person-group> (<year>2019</year>). <article-title>Direct and quantitative evaluation of the major human CYP contribution (fmCYP) to drug clearance using the <italic>in vitro</italic> Silensomes&#x2122; model</article-title>. <source>Xenobiotica</source> <volume>49</volume> (<issue>1</issue>), <fpage>22</fpage>&#x2013;<lpage>35</lpage>. <pub-id pub-id-type="doi">10.1080/00498254.2017.1422156</pub-id>
</citation>
</ref>
<ref id="B21">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Prueksaritanont</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Chu</surname>
<given-names>X.</given-names>
</name>
<name>
<surname>Gibson</surname>
<given-names>C.</given-names>
</name>
<name>
<surname>Cui</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Yee</surname>
<given-names>K. L.</given-names>
</name>
<name>
<surname>Ballard</surname>
<given-names>J.</given-names>
</name>
<etal/>
</person-group> (<year>2013</year>). <article-title>Drug-drug interaction studies: Regulatory guidance and an industry perspective</article-title>. <source>Am. Assoc. Pharm. Sci.</source> <volume>15</volume> (<issue>3</issue>), <fpage>629</fpage>&#x2013;<lpage>645</lpage>. <pub-id pub-id-type="doi">10.1208/s12248-013-9470-x</pub-id>
</citation>
</ref>
<ref id="B22">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Rao</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Patel</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Shukla</surname>
<given-names>A.</given-names>
</name>
<name>
<surname>Parmar</surname>
<given-names>P.</given-names>
</name>
<name>
<surname>Rawal</surname>
<given-names>R. M.</given-names>
</name>
<name>
<surname>Saraf</surname>
<given-names>M.</given-names>
</name>
<etal/>
</person-group> (<year>2022</year>). <article-title>Identifying structural&#x2013;functional analogue of GRL0617, the only well-established inhibitor for papain-like protease (PLpro) of SARS-CoV2 from the pool of fungal metabolites using docking and molecular dynamics simulation</article-title>. <source>Mol. Divers.</source> <volume>26</volume> (<issue>1</issue>), <fpage>309</fpage>&#x2013;<lpage>329</lpage>. <pub-id pub-id-type="doi">10.1007/s11030-021-10220-8</pub-id>
</citation>
</ref>
<ref id="B23">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ratia</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Pegan</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Takayama</surname>
<given-names>J.</given-names>
</name>
<name>
<surname>Sleeman</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Coughlin</surname>
<given-names>M.</given-names>
</name>
<name>
<surname>Baliji</surname>
<given-names>S.</given-names>
</name>
<etal/>
</person-group> (<year>2008</year>). <article-title>A noncovalent class of papain-like protease/deubiquitinase inhibitors blocks SARS virus replication</article-title>. <source>Proc. Natl. Acad. Sci. U. S. A.</source> <volume>105</volume> (<issue>42</issue>), <fpage>16119</fpage>&#x2013;<lpage>16124</lpage>. <pub-id pub-id-type="doi">10.1073/pnas.0805240105</pub-id>
</citation>
</ref>
<ref id="B24">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Saravolatz</surname>
<given-names>L. D.</given-names>
</name>
<name>
<surname>Depcinski</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Sharma</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>2022</year>). <article-title>Molnupiravir and nirmatrelvir-ritonavir: Oral coronavirus disease 2019 antiviral drugs</article-title>. <source>Clin. Infect. Dis.</source> <volume>76</volume>, <fpage>165</fpage>&#x2013;<lpage>171</lpage>. <pub-id pub-id-type="doi">10.1093/cid/ciac180</pub-id>
</citation>
</ref>
<ref id="B25">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shen</surname>
<given-names>Z.</given-names>
</name>
<name>
<surname>Ratia</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Cooper</surname>
<given-names>L.</given-names>
</name>
<name>
<surname>Kong</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Lee</surname>
<given-names>H.</given-names>
</name>
<name>
<surname>Kwon</surname>
<given-names>Y.</given-names>
</name>
<etal/>
</person-group> (<year>2022</year>). <article-title>Design of SARS-CoV-2 PLpro inhibitors for COVID-19 antiviral therapy leveraging binding cooperativity</article-title>. <source>J. Med. Chem.</source> <volume>65</volume> (<issue>4</issue>), <fpage>2940</fpage>&#x2013;<lpage>2955</lpage>. <pub-id pub-id-type="doi">10.1021/acs.jmedchem.1c01307</pub-id>
</citation>
</ref>
<ref id="B26">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Shin</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Mukherjee</surname>
<given-names>R.</given-names>
</name>
<name>
<surname>Grewe</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Bojkova</surname>
<given-names>D.</given-names>
</name>
<name>
<surname>Baek</surname>
<given-names>K.</given-names>
</name>
<name>
<surname>Bhattacharya</surname>
<given-names>A.</given-names>
</name>
<etal/>
</person-group> (<year>2020</year>). <article-title>Papain-like protease regulates SARS-CoV-2 viral spread and innate immunity</article-title>. <source>Nature</source> <volume>587</volume> (<issue>7835</issue>), <fpage>657</fpage>&#x2013;<lpage>662</lpage>. <pub-id pub-id-type="doi">10.1038/s41586-020-2601-5</pub-id>
</citation>
</ref>
<ref id="B27">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stresser</surname>
<given-names>D. M.</given-names>
</name>
<name>
<surname>Broudy</surname>
<given-names>M. I.</given-names>
</name>
<name>
<surname>Ho</surname>
<given-names>T.</given-names>
</name>
<name>
<surname>Cargill</surname>
<given-names>C. E.</given-names>
</name>
<name>
<surname>Blanchard</surname>
<given-names>A. P.</given-names>
</name>
<name>
<surname>Sharma</surname>
<given-names>R.</given-names>
</name>
<etal/>
</person-group> (<year>2004</year>). <article-title>Highly selective inhibition of human CYP3Aa <italic>in vitro</italic> by azamulin and evidence that inhibition is irreversible</article-title>. <source>Drug Metab. Dispos.</source> <volume>32</volume> (<issue>1</issue>), <fpage>105</fpage>&#x2013;<lpage>112</lpage>. <pub-id pub-id-type="doi">10.1124/dmd.32.1.105</pub-id>
</citation>
</ref>
<ref id="B28">
<citation citation-type="web">
<collab>WHO</collab> (<year>2023</year>). <article-title>World health organization</article-title>. <comment>Available: <ext-link ext-link-type="uri" xlink:href="https://covid19.who.int/">https://covid19.who.int/</ext-link>
</comment>(<comment>Accessed January, 2023)</comment>.</citation>
</ref>
<ref id="B29">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yang</surname>
<given-names>K. S.</given-names>
</name>
<name>
<surname>Leeuwon</surname>
<given-names>S. Z.</given-names>
</name>
<name>
<surname>Xu</surname>
<given-names>S.</given-names>
</name>
<name>
<surname>Liu</surname>
<given-names>W. R.</given-names>
</name>
</person-group> (<year>2022</year>). <article-title>Evolutionary and structural insights about potential SARS-CoV-2 evasion of nirmatrelvir</article-title>. <source>J. Med. Chem.</source> <volume>65</volume> (<issue>13</issue>), <fpage>8686</fpage>&#x2013;<lpage>8698</lpage>. <pub-id pub-id-type="doi">10.1021/acs.jmedchem.2c00404</pub-id>
</citation>
</ref>
<ref id="B30">
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Zanger</surname>
<given-names>U. M.</given-names>
</name>
<name>
<surname>Schwab</surname>
<given-names>M.</given-names>
</name>
</person-group> (<year>2013</year>). <article-title>Cytochrome P450 enzymes in drug metabolism: Regulation of gene expression, enzyme activities, and impact of genetic variation</article-title>. <source>Pharmacol. Ther.</source> <volume>138</volume> (<issue>1</issue>), <fpage>103</fpage>&#x2013;<lpage>141</lpage>. <pub-id pub-id-type="doi">10.1016/j.pharmthera.2012.12.007</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>